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. 2016 Jan 1;62(1):45-52.
doi: 10.1093/cid/civ777. Epub 2015 Sep 3.

Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011-2013

Lauren Epstein  1 , Yi Mu  2 , Ruth Belflower  2 , Janine Scott  3 , Susan Ray  4 , Ghinwa Dumyati  5 , Christina Felsen  5 , Susan Petit  6 , Kimberly Yousey-Hindes  7 , Joelle Nadle  8 , Lauren Pasutti  8 , Ruth Lynfield  9 , Linn Warnke  9 , William Schaffner  10 , Karen Leib  10 , Alexander J Kallen  2 , Scott K Fridkin  2 , Fernanda C Lessa  2
Affiliations

Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011-2013

Lauren Epstein et al. Clin Infect Dis. .

Abstract

Background: Significant progress has been made in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections among hospitalized patients. However, the decreases in invasive MRSA infections among recently discharged patients have been less substantial. To inform prevention strategies, we assessed risk factors for invasive MRSA infection after acute-care hospitalizations.

Methods: We conducted a prospective, matched case-control study. A case was defined as MRSA cultured from a normally sterile body site in a patient discharged from a hospital within the prior 12 weeks. Eligible case patients were identified from 15 hospitals across 6 US states. For each case patient, 2 controls were matched for hospital, month of discharge, and age group. Medical record reviews and telephone interviews were performed. Conditional logistic regression was used to identify independent risk factors for postdischarge invasive MRSA.

Results: From 1 February 2011 through 31 March 2013, 194 case patients and 388 matched controls were enrolled. The median time between hospital discharge and positive culture was 23 days (range, 1-83 days). Factors independently associated with postdischarge MRSA infection included MRSA colonization (matched odds ratio [mOR], 7.71; 95% confidence interval [CI], 3.60-16.51), discharge to a nursing home (mOR, 2.65; 95% CI, 1.41-4.99), presence of a chronic wound during the postdischarge period (mOR, 4.41; 95% CI, 2.14-9.09), and discharge with a central venous catheter (mOR, 2.16; 95% CI, 1.13-4.99) or a different invasive device (mOR, 3.03; 95% CI, 1.24-7.39) in place.

Conclusions: Prevention efforts should target patients with MRSA colonization or those with invasive devices or chronic wounds at hospital discharge. In addition, MRSA prevention efforts in nursing homes are warranted.

Keywords: bacteremia; epidemiology; methicillin-resistant Staphylococcus aureus; risk-factors.

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Conflict of interest statement

Potential conflicts of interest. All authors: No potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Case patient enrollment and final study population. *16 case patients excluded because sites did not identify 2 matched controls.
See this image and copyright information in PMC

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